Inspection on 03/12/07 for Astley House Care Centre

This inspection was carried out on 3rd December 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Astley House Care Centre 08/05/09

Astley House Care Centre 27/10/08

Astley House Care Centre 22/05/08

Astley House Care Centre 12/06/07

Astley House Care Centre 06/06/06

Astley House Care Centre 28/06/05

Astley House Care Centre 18/01/05

Astley House Care Centre 24/08/04

Astley House Care Centre 24/02/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Astley House Care Centre 1 Lypiatt Road Cheltenham Glos GL50 2SY Lead Inspector Mrs Janice Patrick Key Unannounced Inspection 3rd December 2007 08:40 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000016373.V356164.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. DS0000016373.V356164.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Astley House Care Centre Address 1 Lypiatt Road Cheltenham Glos GL50 2SY Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 08453 455742 01242 255971 helen.haughton@blanchworth.co.uk Mrs Sally Anne Manby Roberts Mr Jeremy Walsh, Mr Roy Harris Mrs Nandani Cook Care Home 33 Category(ies) of Dementia - over 65 years of age (6), Old age, registration, with number not falling within any other category (27) of places DS0000016373.V356164.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The 7th proposed Dementia Care bed, currently occupied by one named service user without a diagnosis of Dementia, will become a 7th Dementia Care bed when that specified service user no longer requires the bed on their discharge or death. 31st August 2007 Date of last inspection Brief Description of the Service: This care home is registered with the Commission of Social Care Inspection (CSCI) to provide nursing and personal care, predominantly to the older person. It is situated in a residential area near to Cheltenham Town centre and is in close proximity to local shops, amenities and bus services. Accommodation is on four storeys, and consists of 28 single bedrooms and 3 shared bedrooms, all of which have en suite facilities. On each level there are communal rooms with dining areas. Access to all floors is by a passenger lift or stairs. Behind the home is a large paved area, which provides a private and accessible area for residents to sit. The side and front of the building have been designed to provide planted areas with ample car parking. There are steps to the front entrance but there is wheelchair access at the rear. The fees depend on the type of care being provided and the room occupied. Fees at the time of this inspection range from £475.00 (personal care, single room with ensuite) to £654.00 (higher nursing care, single room with bath en suite). The home’s terms and conditions outline any additional charges. The home does not display their previous inspection report. DS0000016373.V356164.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. One inspector carried out this unannounced inspection on one day between 8.40am and 6.30pm. We (The Commission) sent questionnaires to people living in the home and their relatives to seek their views of the services provided. One survey form was returned. Any views and comments received have contributed to this report. As part of the inspection process the care of three people was selected and relevant records were inspected in detail. In addition to this many other related care records and documentation was inspected. Specific areas such privacy and dignity, individuals’ ability to make choices and have their preferences met were looked at. The degree of involvement and control over their care and inclusion in decisions made in the home was also considered. Social and recreational needs were explored along with the arrangements to meet these. The choice and standard of food was inspected. Arrangements for staff training were inspected. The general management of the home including all aspects of health and safety practice were explored and records inspected. The systems required to enable a home to identify shortfalls and improve on these were discussed. What the service does well: What has improved since the last inspection? There are examples of improved care planning where the content is more comprehensive and more focused on the individual. Within the home there are clearer guidelines for the monitoring of blood sugars. The home has been able to provide opportunities for social recreation on a more consistent basis since the last inspection. DS0000016373.V356164.R01.S.doc Version 5.2 Page 6 Communal areas are tidier and look cleaner. The frequent occurrences of avoidable injuries caused by moving and handling hoists and wheelchairs seem to have ceased. The management of potential risks through the use of bedrails has improved. The conservatory area has been tidied. What they could do better: Ensure that the pre admission assessment is an accurate record of the individual’s needs. When people’s needs change or other situations alter, staff need to keep the care plans up to date as the changes occur and avoid completing these in retrospect. Care staff must to be aware of the contents of the care plans so that the correct and agreed care is delivered. Qualified nurses need to improve their arrangements and systems for ensuring important pieces of information are handed over to the next nurse on duty. Medications must always be signed for directly after administration to avoid mistakes. Routines and practices within the home must benefit the people living there. If they are not, as in the case of: • People not getting down to breakfast at an acceptable hour • Having their meals served in a disjointed and disorganised manner • Having to wait at the table for long periods of time after eating before someone moves you • Not being offered a choice at breakfast then a review of staffing levels and staff allocation needs to take place. The home must be provided with a current Fire Risk Assessment. Staff who are ‘in charge’ of the home at any given time must have an understanding of its contents. The home must be provided with the appropriate means to correctly dispose of used continence pads and staff must understand any policies and procedures that relate to this. The home requires a more balanced skill mix where individual qualified nurses on duty are able to rely on senior care staff to organise the smooth delivery of basic care routines. The responsibility for care plan reviews and updating of additional assessments needs to be more fairly shared amongst the staff. The company need to be more transparent/organised about when a task or job, arising from the quality assurance process, is to be completed. They need to then share this with the Registered Manager. DS0000016373.V356164.R01.S.doc Version 5.2 Page 7 Requirements made during the previous inspection in June 2007 were reviewed for compliance. Four remain unmet. Unmet requirements impact upon the welfare and safety of residents. Failure to comply by the revised timescale may lead to the CSCI considering enforcement improvement to secure compliance. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. DS0000016373.V356164.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000016373.V356164.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who are planning to live in this home are having their needs assessed prior to their admission, but the recording of these is not always accurate and could lead to needs being misinterpreted or missed. DS0000016373.V356164.R01.S.doc Version 5.2 Page 10 EVIDENCE: Pre admission assessments were seen for two people who had moved into the home recently. They had both been assessed in hospital. One person remembers this happening and said that staff in the home had been very kind and welcoming. The pre admission assessment format gives the assessor several options, which can be ticked against. Some areas require further comment in order to make the assessment more comprehensive. One such additional comment said that the person required care for ‘pressure ulcer prevention’ which, when cross referenced with other assessments was confusing as these did not indicate a problem in this area. On discussing this with the nurse who had carried out the assessment she had meant this to refer to leg ulcers, which the person had a history of. These were not related to problems caused from inappropriate pressure and therefore this entry gives a misleading picture of this person’s requirements. The nurse did not feel that she could amend this assessment in retrospect. We suggested that it should be amended, as it is not factual. Both admissions had important additional assessments relating to the safe moving and handling and falls completed after 36 hours of admission. DS0000016373.V356164.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People living in this home are being cared for in a way that maintains their privacy and dignity. However, even though care plans are in place to offer staff direction; shortfalls in the staffs’ knowledge of their content and a lack of organised communication is leading to care needs not being adequately met and is putting people at risk. EVIDENCE: We have assessed this outcome as poor because of how many people have been or are affected by practices that put them at risk. Records of care for several people living in the home were inspected and crossreferenced with the actual care they were receiving. The care plans for three people were inspected in detail. DS0000016373.V356164.R01.S.doc Version 5.2 Page 12 In the previous Key Inspection of this home in June 2007, care plans seen for diabetes were not giving adequate guidance to staff when potential situations occurred such as hyperglycaemia and hypoglycaemia. A senior member of staff spoken to at that time was also not sure how a particular person’s unstable blood sugars should be monitored within the home. In this inspection the content of one care plan for diabetes was far more specific and senior staff were aware of what equipment was available to them if they needed to monitor unstable blood sugars before contacting a General Practitioner (GP). One set of care plans had been signed by the person who was receiving the care, demonstrating that she had some involvement in its planning. Another person’s health had deteriorated since the previous inspection. Although care plans demonstrated review, some required areas of adjustment and one was totally irrelevant although the reviewing nurse had still made the comment ‘care as above’. This therefore offers incorrect guidance to staff. It is obvious that there has been some improvement to the contents of some care plans. There is still however a gap between the written care plan and the care staffs’ knowledge of its content. Both the Registered Manager and Registered Nurse, who are mainly responsible for the care plans, said that the care staff are not in the habit of referring to the written care plans for guidance. This does have a negative impact on those living in the home if the staff are not adhering or are ignorant of the agreed plan. An example of this was a person we observed on arrival at the home. This person’s care plan for the prevention of pressure sores clearly stated that she should be seated on a pressure relief cushion. She was not and remained like this until I pointed the shortfall out. Two further pieces of recording caused concern and lead to a poor outcome for the individual’s. One relates to the apparent development of a pressure sore on someone’s heel. According to the records this could have been avoidable. The first record was an entry by one of the night staff saying: ‘darkened area on the right heel, threatening pressure sore’. During the next day the pressure sore risk assessment was reviewed. This comprises of a set of questions, which are answered and depending on the score at the end should ‘trigger’ further action. Although the skin on this person’s heel had clearly changed the questions did not initiate any change in the assessment and it failed to ‘trigger’ further action. The care plan did refer to ‘slide sheets needing to be used to avoid scuffing of the skin’. There was no other entry demonstrating any preventative action or monitoring of this until, fifteen days later when another entry says: ‘skin loss to right heel’. Then there were records showing the care given to a pressure sore. DS0000016373.V356164.R01.S.doc Version 5.2 Page 13 Another observation had been made by night staff on two separate nights and recorded. This was of ‘open blisters’ to an individual’s skin. There were no other records indicating that any action or review had taken place within the four days of this being initially observed and this inspection. The nurse spoken to at this inspection was unaware of the condition of this person’s skin. The Registered Nurse on duty confirmed that they had been looking into ways of improving communication between staff regarding peoples’ care and health needs. One decision has been to return to a collective handover at the beginning of staffs’ shifts so that they are aware of any changes in peoples’ health before they start their daily work. Senior staff have discussed how to use the diary more effectively. We suggested that dates for reviewing wounds or skin that is ‘at risk’ should also be placed in the diary so that there is no chance of these tasks being missed. Currently a review date for a wound is only written in the individual’s care record. If communication systems are not effective then situations as described above place people at risk. The Registered Nurse on duty explained that it is a real struggle to find time to complete care records as and when they need to. It is however a legal requirement to record the care given to people. It is also vital that any monitoring or reviews carried out are recorded and handed over to the next nurse. Either there is a general shortage of staff and they cannot cope with all that has to be done or there is a lack of competency in the staff team. This is discussed further in the outcome for staffing. We were concerned about the lack of cleanliness of one person’s mouth and remained doubtful, although told, that this person’s mouth had been cleaned. Reasons for this were that the teeth had a white coating at their base and the toothbrush and toothpaste were very dry. The person said that they required help to do this and that their mouth had not been cleaned that morning. Linked to this concern several people (seven counted, just over a third) arrived downstairs for their breakfast at between 11am and 11.40am with very dry mouths. Although told that cups of tea are offered early morning (approximately 7am), this means that people are having a very long gap between their last meal in the evening and the first one of the day. This would not be meeting their fluid and nutritional requirements to remain healthy and after talking to some nor their preferences. An area of specific risk to two people was discussed, this related to falls and staff explained what action they had taken to try and reduce these. We saw what had been carried out but none of this had been recorded. Although the outcome for these two people had improved, the home would not be able to demonstrate within its written records, whether it had responded to an identified risk. DS0000016373.V356164.R01.S.doc Version 5.2 Page 14 Since the last inspection there has been a review of all bedrails. Several seen in use in the inspection of June 2007 were a potential risk to the person in the bed. We were concerned that staff had not identified the shortfalls as potential risks. During this inspection there was evidence to show that reviews had been carried out and all bedrails that were separate to the actual bed frame had been removed. Alternative equipment was being used such as ‘crash mats’ that do not pose a risk of entrapment. Only one person still had bedrails in place but these were an integral part of the bed frame and were therefore positioned in a way that could not cause entrapment. Part of the morning medication round was observed. We noted that there were still several medicines to give out at 11am. This may have been due to the distraction of the inspection on this particular morning. On inspection of the Medication Administration Records (MAR) later in the afternoon, two peoples medication, that we observed being given in the morning, were not signed for. There were several other gaps on various MAR sheets that were again, omissions in signing. One MAR sheet lacked any recording of administration of a particular medicine for sixteen days and was still like this during this inspection. Although it was later explained that there had been a manufacturing problem and no stock had been delivered, this had not been recorded anywhere. The Registered Nurse also explained that she had discussed the implications of the person not having the medicine with the GP, but this also had not been recorded and was actually entered into the care notes following this conversation. Although no one had been harmed from these shortfalls, this is extremely poor practice, which could easily lead to mistakes and misinterpretations being made. This puts people at risk. Although the Registered Nurse explained that she visually audits the records, clearly there are shortfalls in this process. When the MAR sheets for two further people were cross-referenced with the stock left, they demonstrated that antibiotics were being administered at the correct number each day. The stock count for several other medications that could be open to abuse corresponded with the records kept. There were examples of pots of creams found in bedrooms where the name on the container did not correspond with the occupant of the room. Apart from the legal implications of a prescribed item being used for someone else other than it was prescribed for, this is poor infection control practice. In one person’s wardrobe there were out of date wound dressings belonging to other people. We observed staff speaking politely and in a courteous manner at all times to people although during this inspection very few staff were seen in the communal areas. DS0000016373.V356164.R01.S.doc Version 5.2 Page 15 We did not observe any incident that publicly compromised anyone’s dignity or privacy. One person living in the home was avoiding using the main lounge and isolating herself in her bedroom because of her embarrassment at having to be moved by a moving and handling hoist. The Registered Nurse was aware of this and keen that this situation should be handled in an understanding way in order to gain this person’s trust. This is a good example of staffs’ awareness of these issues. One relative said that she was very happy with the care that her mother was receiving. Another relative said that she felt reassured that her mother is receiving all the care she required and felt sure she would be encouraged to eat her food if needed. There were entries in the care records that show that external healthcare professionals visit the home from time to time. These include the Chiropodist, Continuing Healthcare Nurse, Continence Advisor, Mental Health Team and the GP. DS0000016373.V356164.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living in the home are being given better social and recreational opportunities but their ability to make choices and have their preferences met are limited. EVIDENCE: We have tried to fair in the assessment of this outcome and recognise improvements in the activity arrangements, but the home is not running at all times in the best interest of the people living there and they are having to be compliant to routines that do not necessarily enhance their quality of life. During the last inspection in June 2007 people were not getting consistent opportunities for recreation. Arrangements were often being cancelled because the activities co-ordinator had to remain on care duties instead of completing the designated activity hours. Prior to the last inspection relatives also identified this as a shortfall in surveys sent to them by the Commission. It was also identified as a weakness within the company’s own satisfaction surveys. DS0000016373.V356164.R01.S.doc Version 5.2 Page 17 In response to this senior company staff discussed this with the Registered Manager and the aim to protect the designated activity hours from then onwards. The Registered Nurse on duty said that this was usually happening and a comment from one relative indicated that activities were taking place in the week. Unfortunately on the day of this inspection and for the day after the activity co-ordinator was off sick so very little stimulation or interaction was observed. The home was also short of one member of staff in the afternoon so this left no room for the remaining staff to stop and chat or organise any activities. The care plans for activities require improvement. They are extremely brief in some cases. The psychiatric team has reviewed one person since the last inspection and on discussion with the Registered Manager she explained what arrangements had been made to provide this person with stimulation and appropriate interaction. This included one to one time with the activities co-ordinator and for staff to make sure she has music on in her bedroom, as this person particularly enjoys this. However, when we visited this person at 10.15am she was sitting in her chair talking to herself. There was no TV or radio on, but she responded in an animated way. The Registered Nurse explained that she had asked staff to switch the radio on and said at times she makes sure this is done herself. Again this demonstrates in a small but important way the gap between the written care plan and the staffs’ knowledge and practice. The activities care plan for this person was not overly comprehensive however and did not give staff a lot of guidance. The care plans for activities generally require improvement. When staff helped this person to eat and drink they demonstrated patience and kindness. When we arrived there were three people in the lounge. One said how much she was enjoying the television programme and the other two were asleep. Several were observed during the day spending a large amount of their time sleeping. One person read her newspaper; another said she prefers to stay in her room and was enjoying a quiz book. We remain concerned about people’s ability to have their choices met and the fact that again the home seems to be task oriented resulting in people having to wait or fit in with the home’s routine. DS0000016373.V356164.R01.S.doc Version 5.2 Page 18 Between 11am and 11.40am, seven people were brought down to the dining room for their breakfast. The lateness of this was pointed out and the Registered Nurse said that this was not normal. No one seemed to have an explanation as to why people were coming down so late for their first meal of the day. Breakfast was observed and we asked one person what he would like for his whilst the carer went into the kitchen. He replied ‘eggs and bacon would be nice’. The carer returned with a bowl of cornflakes having not originally asked him. We pointed out that the written menu says: ‘a cooked breakfast is available on request’. This was clearly a case where someone would have enjoyed this but would not have thought to request it. We feel that everyone should be advised of the options. The Registered Nurse said that people are asked on admission what they prefer and thought that what maybe happening is from then on, unless a member of staff gives an option, it remains the same. It was confirmed that one person has a cooked breakfast most mornings, but it is understood that he always has. A variety of alternatives were seen at lunchtime including several forms of food such as minced or pureed for those who cannot chew or swallow particularly well. Teatime however was disjointed with people waiting long periods to be served and a cup of tea that arrived well after the food. One member of staff was serving in the dining room and trying to manage, other staff were helping to feed several people and delivering trays to bedrooms across four floors. Visitors in the past have said they can visit their loved ones at anytime and this was witnessed during this inspection. One visitor was worried about his relative but indicated that he trusted the nurse on duty to sort things out. The Registered Nurse said that an arrangement has been made with this relative for him to be able to leave notes in the home diary if he needs to pass anything on. We would expect a member of staff to always be available and around on the ground floor for this reason and the supervision of people in the communal rooms. DS0000016373.V356164.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living in this home are made aware of how to complain and are given a response if they do so. And, although training in abuse awareness is given to staff and the home has policies in place designed to protect people, the routines of the home are not always protecting people’s basic rights. EVIDENCE: Again we have tried to be proportionate in our assessment of this outcome. The home’s complaint policy is prominently displayed and gives a complainant options for contact should they wish to raise a complaint. According to the home’s complaint file there has been one complaint since the last inspection in June 2007. This related to a lack of hairdressing and chiropody being provided to a particular person despite relatives thinking arrangements had been made for this. Relatives were also not happy with the state of the clothes once returned from the laundry. The complainant was responded to fully within the timescale stated in the complaint procedure. The one relative who responded to our questionnaire said she could not remember the homes procedure for making a complaint, but that she had had no cause to raise one. DS0000016373.V356164.R01.S.doc Version 5.2 Page 20 Staff who work for the Blanchworth Group receive a training session in the Protection of Vulnerable Adults and Challenging Behaviour during their induction training. One member of staff acknowledged that they had received this training. A senior member of the staff was able to explain what she would immediately do if someone reported an incident of abuse, but had limited knowledge beyond this and was unaware of the county’s Safeguarding Adults Protocol despite the home including this in their Protection of Vulnerable Adults Policy and Procedures. Within the homes routine and staff practices there are shortfalls that impact on people’s basic rights. For example access to food when they want it and their ability to have some control over these areas of life. Evidence from this inspection demonstrates that for some people this is not happening and that through other areas of poor practice they are not being protected as well as they could be. This requires exploration by senior staff and the situation addressed. DS0000016373.V356164.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 25 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living in this home benefit from basic arrangements being in place to ensure the home is safe and fairly clean, it would be fair to say however that the replacement of some furnishings would further enhance the environment. EVIDENCE: The home smelt far fresher and looked cleaner than on the previous inspection. The Registered Manager said she likes areas to be tidy and it was noticeable that she was back in the home ensuring that a certain standard was being upheld. Various maintenance jobs were being carried out on the day of this inspection. The home has been allocated one full day for this work to be carried out by one of the company’s maintenance team. A gardener was also in attendance. DS0000016373.V356164.R01.S.doc Version 5.2 Page 22 The Registered Manager confirmed that the present arrangement where staff enter in a book during the week, odd jobs that need attention by the maintenance person was working. She also confirmed that urgent problems were usually addressed quickly, although larger jobs such as refurbishment and redecorating could take sometime to be organised and then she would not always be sure when task was planned for. Carpet stains and dirty looking armchairs in communal areas still let the overall appearance down and would be having an impact on good infection control. We noted that these issues had been identified and discussed as part of a quality assurance audit of the home by a senior company manager in August 2007 and a recommendation for the replacement of some carpets was made. This was also in response to comments made to the company from relatives via the satisfaction surveys sent out by the company. When asked, the Registered Manager was not aware of any replacement organised. We did note that the carpet in bedroom 17 had been replaced. A water leak from one of the large windows in this room was pointed out to the Registered Manager during this inspection. We witnessed a moving and handling manoeuvre being carried out correctly, however the wheelchair used to transport the person did not have any footplates. Staff explained that it was safer not to have footplates for this particular person, as she tended to kick her legs out. This therefore needs to be recorded in a risk assessment, as this would normally be seen as unsafe practice. Accident forms were inspected during this inspection and there were no accidents that appeared to be caused by bedrails or wheelchairs as there had been in June 2007. The safe disposal of continence pads, in line with Department of Health’s guidance, was not taking place during the last inspection. The amended policy was up on the wall for staff to read but both senior staff on duty were unsure about this. The relevant equipment required to fulfil the policy was also not in place. Colour coded plastic aprons and gloves were seen being worn by staff when carrying out various tasks and serving food. DS0000016373.V356164.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Despite training arrangements being in place the home lacks an essential skill mix to enable it to run smoothly and meet the needs of those living there at all times. EVIDENCE: This outcome has been assessed as adequate using the Commissions assessment tool for this purpose, however there are shortfalls that are having an impact on the lives of people living in the home and which require addressing. We were assured that the home was fully staffed in the morning and acknowledge there was a shortfall in one member of staff between 4pm and 8pm, which was having quite an impact. There is however enough evidence in this report to suggest that this may not be the case or that alternatively, the daily routines are not appropriate and need altering. Either way the staffing numbers and routines require review. Six out of twelve staff have completed the National Vocational Qualification (NVQ) in Care this meets with the National Minimum Standards of 50 of the care staff being trained to this level. DS0000016373.V356164.R01.S.doc Version 5.2 Page 24 Recruitment practices were not inspected during this inspection. One member of the staff had been newly recruited to the company since the last inspection and one Registered Nurse had been transferred from a sister home and was already known to the Inspector. Recruitment of staff is centralised at the company’s head office and practices have been inspected by the CSCI recently at several other homes within the same group with only minor shortfalls. Electronic staff records demonstrate that all staff complete an induction training. All trainings are provided from within the company and include awareness on several subjects such as health and safety, fire safety and safe moving and handling. The company provides further trainings, which are also updated but there would appear to be a gap between the training provided and the lack of some staffs’ skills. Such • • • • as: care planning and review, recording skills effective communication, supervisory skills and general organisational skills. DS0000016373.V356164.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The current management arrangements for this home are currently fragile for various reasons. There is not an adequate infrastructure within the home alone to ensure that people needs are met and that the smooth running of the home continues. EVIDENCE: Although this outcome has been assessed as adequate using the Commissions assessment tool for this purpose, we have concerns that need addressing. Requirements made by the Commission following the last Key Inspection in June 2007 were discussed and evidence gathered to demonstrate compliance. DS0000016373.V356164.R01.S.doc Version 5.2 Page 26 The requirements that have been complied with have been removed from the requirement section within this report. During the last inspection we were concerned about the day-to-day management of the home and the lack of staff supervision and those concerns remain. For a good part of this year the Registered Manager has not been able to be consistently present in the home for good reasons explained to us. During the last inspection the Deputy Manager was present, this person has since left the home and the Registered Manager is currently in the home on a more frequent basis. There is no Deputy Manager in position but one of the Registered Nurses is taking a lead on several systems within the home and is predominantly present during the daytime when the Registered Manager is not present. This person appeared to know the people that live in the home, well and acknowledged some of the shortfalls identified during this inspection such as care planning and the disorganised routines but lacks further support to make a consistent improvement. Feedback from this inspection was predominantly given to the Registered Nurse as the Registered Manager finished her shift before the end of the inspection. Senior company managers visit the home regularly to monitor and support the staff. These visits also help comply with one of the requirements from the Care Home Regulations 2001 where an unannounced visit must be carried out (a Regulation 26 visit). The last record for this seen in the home was dated October 2007. Senior managers also carry out quality assurance audits and the company collates comments from relative and resident surveys. These results are made available in the home. The process thereafter of planning action, within certain timescales to address shortfalls and improve the service remains unclear. The Registered Manager was also unclear as to when certain things would be addressed. This report still identifies some fundamental shortfalls that were identified in June 2007 which have a real impact on those living there. We do acknowledgement however that some have been addressed such as the activities and that some requirements have been complied with. Records of the safe keeping of two peoples’ personal monies were inspected. The small amounts counted corresponded with the records. Receipts were seen for purchases made by anyone else but the person and two signatures were present at any withdrawal. Consideration should be given to improving the security of where these are held. DS0000016373.V356164.R01.S.doc Version 5.2 Page 27 The Registered Manager explained that when she is on duty she supervises staff by getting out and about in the home and observing practices. The Registered Nurse spoken to said she is trying to maintain certain systems and improve them such as the care planning. She was also aware that formal staff supervision sessions were behind due to the absence of the Registered Manager at times within the year. The senior staff present agreed that there is a lack of additional competent leaders and supervisors within the basic care team. This results in difficulty in delegating certain tasks that should be within the remit of other levels of staff within the home. We would have serious concerns if the Registered Manager were to be away from the home again for any length of time. The company would need to ensure appropriate and adequate support to the well-meaning staff left. The maintenance person carries out basic health and safety checks and keeps records of these, which were seen during this inspection. The Registered Manager confirmed that she is still unaware of the Home’s Fire Risk Assessment as required by the Fire Officer, but believes the company is dealing with this. We will seek compliance with this through the Registered Provider. DS0000016373.V356164.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X 3 X X 3 2 STAFFING Standard No Score 27 1 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 2 DS0000016373.V356164.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 12(1)(a) Requirement Timescale for action 31/01/08 2 OP8 12(1) (a-b) 3 OP8 17 Schedule 3(k) 4 OP8 12(1)(a) The Registered Person must ensure that all staff delivering care within the home are aware of the guidance given within individuals’ care plans and that they adhere to this in order that the correct and agreed care is given to meet that need. The Registered Person must 31/01/08 ensure that staff assess and monitor effectively the potential risk of individuals developing pressure sores and that the agreed plan of action is implemented. The Registered Person must 31/01/08 ensure that staff record their actions or findings during the course of their shift, this is with particular regard to the ongoing monitoring of a situation or a service user’s condition. The Registered Person must 21/01/08 ensure that service users have access to fluids at all times and that the gap between the last food/meal in the evening and the first food/meal in the morning does not exceed 12 hours. And DS0000016373.V356164.R01.S.doc Version 5.2 Page 30 5 OP8 12(1)(a) that if some require this sooner or prefer to have this sooner it is provided. The Registered Person must ensure that all service users who require help to maintain their oral hygiene receive this and that in order to promote oral health that fluids are provided in intervals that prevent service users mouths becoming dry. 21/01/08 6 OP9 13(2) Schedule 3 (3)(i) 7 OP12 12(3) 8 OP19 16(2)(c) 9 OP19 23(4) The Registered Person must ensure that any gap in the administration of a medicine that has been prescribed by a medical practitioner has a written explanation for this. And that: Any medicine administered is signed for straight after administration. The Registered Person must, in meeting service users’ personal care, healthcare needs and meeting their general welfare, so far as is practicable, their wishes and feelings must be ascertained and met. This is with particular regard to the general routines of the home and in the opportunities for choosing what they would like to eat (Timescale of 01/08/07 not fully met) The Registered Person must arrange for floor coverings and chairs that remain heavily soiled after cleaning to be replaced. (Timescale of 30/09/07 not met) The Registered Person must provide the home with a completed fire risk assessment and make appropriate staff aware of its content and DS0000016373.V356164.R01.S.doc 21/01/08 31/01/08 31/03/08 21/01/08 Version 5.2 Page 31 10 OP27 18(1)(a) 11 OP36 18(2) guidance. (Timescale of the 1/8/07 & 30/11/07 not met). The Registered Person must provide enough staff in number and competency to meet the needs of all the service users and also take into account the size of the building in doing this. (This requirement has been repeated from the three previous inspections. last timescale of the 30/11/07 not met). The Registered Person must make arrangements for staff to be adequately supervised at all times. 21/01/08 31/01/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP9 OP35 OP36 Good Practice Recommendations Consideration should be given to a weekly-recorded audit of all MAR sheets. A more secure place should be chosen for the safe keeping of service users’ personal monies. Staff should be receiving a minimum of 6 supervisions sessions per year, which should be recorded. DS0000016373.V356164.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection South West Regional Office 4th Floor Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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